8 ms·

Health Insurance Shouldn't Be Tied to Employers

110 points by aaronbrethorst 6y ago

deleted 6y ago
[deleted]
Barrin92 6y ago
I think employer based healthcare works fine in more corporatist countries. Here in Germany we have a multi-payer system that includes the option for employer-based plans, but it's embedded in a culture that isn't going to throw you on the street in a pandemic, and there is of course the rest of the public healthcare system to catch people. In federal states purely national systems are hard to realise. The US has the same issue I think, not to mention that the federal government doesn't always seem to be in good shape. Maybe better to go deeper than just healthcare and ponder whether the liberal capitalism needs to taken down a notch in favour of putting other stakeholders first instead of centralising healthcare further.
- robert_foss 6y ago
  Just like the US system, the German one has a lot of inefficiencies. How many people are employed in the health insurance sector? It is a _large_ industry, and someone has to pay their salaries. How much paperwork do have to deal with regarding health insurance? Having lived in Canada and Sweden, both which have a single payer system, I can tell you that the life improvement is very real. That being said, I can only assume the German system is less broken than the US one. People with no jobs do have access to health insurance here.
- nicbou 6y ago
  That's incorrect. German health insurance is not tied to your employer. Losing your job has no impact on your coverage, and your employer has no say on how you are insured. If you are curious about how German health insurance works, I wrote a long, detailed, thoroughly verified guide about it for expats. It's a good intro to the system. https://allaboutberlin.com/guides/german-health-insurance https://allaboutberlin.com/guides/german-health-insurance
  - Barrin92 6y ago
    I am German and you're not correct. There are several types of public insurance. If you've chosen to be a member of a Betriebskrankenkasse or Innungskrankenkasse, your insurance status is tied to your job, because that insurance is provided by your employer. Should you lose your job you are entitled to a month or so of additional coverage called nachgehender leistungsanspruch and you can obtain public health insurance through a non jon-related public insurer. That's why the German system is universal (you're never going to be uninsured), but the option for employer-based insurance exists and is quite popular.
    - nicbou 6y ago
      Fair point. This is a blind spot in my research, and I will amend the article when I find the time. They at least deserve a mention. There are no notable differences: same price, same coverage, and no particular gotchas. That being said, I can't think of a scenario where you'd want to keep a specific job for health insurance reasons. In that sense, your health insurance is not tied to your job. If you were with a BKK, you'd fall back into the public system, which should provide equivalent coverage.
dmckeon 6y ago
The impact to labor mobility is significant: people who rely on employer-provided health care would be more reluctant to change jobs if there is any risk of discontinuity of health care for chronic conditions, or a higher cost for any conditions pre-existing before the new job starts. The US has not had indenture by name for decades, but we still have it via health care.
missedthecue 6y ago
It's not really tied to employers. There's no law stopping you from purchasing it yourself. The government just gives a tax break to companies who give it as a benefit. So they hugely incentivize it.
- pmiller2 6y ago
  You seem to be being deliberately obtuse. Yes, you could literally go buy the exact same amount of coverage as an individual as you’d get from an employer-sponsored group plan. But, since even employer-sponsored plans are frequently quite expensive, especially if you have children, that effectively prevents most people from doin so.
  - aaomidi 6y ago
    You actually can't really do that since workplace health insurance plans actually cover some of the costs that insurance bills. Like, your work literally pays a bill. This isn't something that you can replicate.
    - genocidicbunny 6y ago
      I'm pretty sure given enough money, you can replicate it, but that's also exactly the problem -- given enough money. More and more these days it seems there's no amount that's enough.
    - pmiller2 6y ago
      You're actually agreeing with me, I think. I said you can buy the exact same amount of coverage as the workplace plan, but the price will be so high as to be prohibitive.
  - 1auralynn 6y ago
    As someone who has been buying my own health insurance for 15 years, you absolutely cannot buy the same exact coverage as an employer. They have MUCH better plans than what are available to individuals (in the three states I've lived in, anyway).
andrewstuart 6y ago
In Australia, health insurance isn't related to employment at all. It seems a strange idea that it should somehow be connected to your employer. I can't see any reason why it would, only reasons why that would make things problematic and complex for no gain.
- splintercell 6y ago
  IIRC, It was a tax benefit introduced to the employer back during WW2, those who were offering health benefits to their employees.
  - willcipriano 6y ago
    It was in response to a national wage freeze. Due to WW2 too few workers existed for the jobs available as such any one worker had incredible bargaining power. Wages were frozen by law[0] and firms found other benefits to offer in order to attempt to compete with each over for workers. [0]https://en.m.wikipedia.org/wiki/Stabilization_Act_of_1942 https://en.m.wikipedia.org/wiki/Stabilization_Act_of_1942
qalmakka 6y ago
I'm European, and I think that healthcare should be considered a human right. Not giving someone in need a potentially life-saving medical treatment is completely unfair, and a big red flag honestly. Life doesn't give the same opportunities to everyone, some people have been born in better environments or have simply been less fortunate then others, and I think it's the state's responsibility to create a system where these things are taken into account. Denying this is plain greed from the richest who don't want to subsidize healthcare for the poorest, without realizing that a society where people are less worried about their future would benefit them too; it puzzles me that so many people on the other side of the pond think of this almost as if it was some form of bolshevism while it is instead just plain and simple basic human decency.
- Darmody 6y ago
  This is not about the rich subsidizing the poor. That's not how healthcare works in Europe. Y pay my share as everybody else for our healthcare. If someone can't pay it is still covered by all the other people paying. That doesn't mean the rich are subsidizing us. The problem with the healthcare in the US goes beyond that. Everything is insanely corrupt to make things expensive. That's why they spent way more per capita that many other countries but get almost nothing in return.
  - JumpCrisscross 6y ago
    > If someone can't pay it is still covered by all the other people paying. That doesn't mean the rich are subsidizing us. That’s exactly what it means. The person who couldn’t pay has their costs subsidised by those who do. If nobody in the system pays more than they use, and anyone uses more than they pay, the system tends de-stabilises.
    - DerDangDerDang 6y ago
      It’s not ‘the rich’ paying in that case. It’s ‘the majority’.
      - 6y ago
PostThisTooFast 6y ago
This is a case of incompetent legislation degrading the lives of millions of people. The insurance-benefits loophole in the WWII salary caps should’ve been plugged as soon as it emerged. But nope. Now we have a world-class mess.
blackrock 6y ago
Please do something useful and fund a movement to dissociate the two. People are imprisoned to their employers that provides decent health care, especially those with family and children. Health care costs should be completely 100% tax deductible. When I go to the dentist, I have no clue what he is going to charge me. He could price a procedure at $1000 or $5000. I, as an individual, have no ability to negotiate with him about his price. I just know that I have a damn root canal, and I’m dying in pain, so fix it! And then, you’re slapped with the expensive bill.
- dwd 6y ago
  Rather than health care costs being completely 100% tax deductible, you just need the health insurance premiums to be covered, and you can index the deduction against taxable income if you want. The kicker, and this is where the US mindset gets hung-up is that you need to incentivise the insurers to cover everyone (including preexisting conditions) by making it mandatory for everyone to have health insurance so there are enough healthy people (who don't make claims) in the system to make it profitable.
  - JumpCrisscross 6y ago
    > you need to incentivise the insurers to cover everyone (including preexisting conditions) by making it mandatory for everyone to have health insurance There’s a stupid simple workaround. Everyone gets taxed equal to the lowest-tier health insurance. When a health insurer signs someone up, they can claim from this kitty. Insurers can’t deny signing someone up for the lowest tier. When insurers breach certain actuarial limits, for example, if their pool of insured proves unusually old or sick, they can claim from this kitty. If the limits are properly set, healthy people foregoing insurance becomes a non-issue. They’re pre-paying for a benefit they fail to claim.
    - brokensegue 6y ago
      Isn't this basically what Obamacare tried to do? Except with a lower tax?
fallingfrog 6y ago
When the current health insurance system was created in the 1950’s, there was a very specific family structure in the United States where the man would work for a wage, and the woman would stay at home with the children. So if the health insurance was attached to the man’s job, then she was dependent on him for healthcare. So you have to understand that on the American right wing, the current health care system is seen as a lynchpin of the “American way of life”. Not only that but as many black people work the kinds of low wage jobs that don’t offer health care. If we created a public system for everyone, then taxes on white income and property would be used to pay for black people to have health care, something which in the United States is a hard sell. That’s why you will often see people holding signs saying something to the effect of “racial equality is communism”.
amanaplanacanal 6y ago
This biggest problem with employer paid health insurance is that the people who receive it are sheltered from a lot of the problems with the current system. It’s easy to say everything’s fine when you are happy with your current situation. Imagine if senators and congress had to buy their own individual plans.
- dpeck 6y ago
  this is the answer to why so many things are the way they are. Those with enough money to make something not be a problem, don't tend to even think about it again after writing the check/swiping the card.
chansiky 6y ago
> But employer-based insurance is heavily subsidized by the federal government. I don't know enough about how the health insurance beast works, but it would seem that if the federal government stopped giving an unfair advantage to organizations, then the unfair advantage would stop existing for these organizations that were given the unfair advantage and fairness would somewhat return for individual persons.

deleted 6y ago

[deleted]

I think employer based healthcare works fine in more corporatist countries. Here in Germany we have a multi-payer system that includes the option for employer-based plans, but it's embedded in a culture that isn't going to throw you on the street in a pandemic, and there is of course the rest of the public healthcare system to catch people. In federal states purely national systems are hard to realise. The US has the same issue I think, not to mention that the federal government doesn't always seem to be in good shape. Maybe better to go deeper than just healthcare and ponder whether the liberal capitalism needs to taken down a notch in favour of putting other stakeholders first instead of centralising healthcare further.

robert_foss 6y ago
Just like the US system, the German one has a lot of inefficiencies. How many people are employed in the health insurance sector? It is a _large_ industry, and someone has to pay their salaries. How much paperwork do have to deal with regarding health insurance? Having lived in Canada and Sweden, both which have a single payer system, I can tell you that the life improvement is very real. That being said, I can only assume the German system is less broken than the US one. People with no jobs do have access to health insurance here.
nicbou 6y ago
That's incorrect. German health insurance is not tied to your employer. Losing your job has no impact on your coverage, and your employer has no say on how you are insured. If you are curious about how German health insurance works, I wrote a long, detailed, thoroughly verified guide about it for expats. It's a good intro to the system. https://allaboutberlin.com/guides/german-health-insurance https://allaboutberlin.com/guides/german-health-insurance
- Barrin92 6y ago
  I am German and you're not correct. There are several types of public insurance. If you've chosen to be a member of a Betriebskrankenkasse or Innungskrankenkasse, your insurance status is tied to your job, because that insurance is provided by your employer. Should you lose your job you are entitled to a month or so of additional coverage called nachgehender leistungsanspruch and you can obtain public health insurance through a non jon-related public insurer. That's why the German system is universal (you're never going to be uninsured), but the option for employer-based insurance exists and is quite popular.
  - nicbou 6y ago
    Fair point. This is a blind spot in my research, and I will amend the article when I find the time. They at least deserve a mention. There are no notable differences: same price, same coverage, and no particular gotchas. That being said, I can't think of a scenario where you'd want to keep a specific job for health insurance reasons. In that sense, your health insurance is not tied to your job. If you were with a BKK, you'd fall back into the public system, which should provide equivalent coverage.

dmckeon 6y ago

The impact to labor mobility is significant: people who rely on employer-provided health care would be more reluctant to change jobs if there is any risk of discontinuity of health care for chronic conditions, or a higher cost for any conditions pre-existing before the new job starts. The US has not had indenture by name for decades, but we still have it via health care.

missedthecue 6y ago

It's not really tied to employers. There's no law stopping you from purchasing it yourself. The government just gives a tax break to companies who give it as a benefit. So they hugely incentivize it.

pmiller2 6y ago
You seem to be being deliberately obtuse. Yes, you could literally go buy the exact same amount of coverage as an individual as you’d get from an employer-sponsored group plan. But, since even employer-sponsored plans are frequently quite expensive, especially if you have children, that effectively prevents most people from doin so.
- aaomidi 6y ago
  You actually can't really do that since workplace health insurance plans actually cover some of the costs that insurance bills. Like, your work literally pays a bill. This isn't something that you can replicate.
  - genocidicbunny 6y ago
    I'm pretty sure given enough money, you can replicate it, but that's also exactly the problem -- given enough money. More and more these days it seems there's no amount that's enough.
  - pmiller2 6y ago
    You're actually agreeing with me, I think. I said you can buy the exact same amount of coverage as the workplace plan, but the price will be so high as to be prohibitive.
- 1auralynn 6y ago
  As someone who has been buying my own health insurance for 15 years, you absolutely cannot buy the same exact coverage as an employer. They have MUCH better plans than what are available to individuals (in the three states I've lived in, anyway).

andrewstuart 6y ago

In Australia, health insurance isn't related to employment at all. It seems a strange idea that it should somehow be connected to your employer. I can't see any reason why it would, only reasons why that would make things problematic and complex for no gain.

splintercell 6y ago
IIRC, It was a tax benefit introduced to the employer back during WW2, those who were offering health benefits to their employees.
- willcipriano 6y ago
  It was in response to a national wage freeze. Due to WW2 too few workers existed for the jobs available as such any one worker had incredible bargaining power. Wages were frozen by law[0] and firms found other benefits to offer in order to attempt to compete with each over for workers. [0]https://en.m.wikipedia.org/wiki/Stabilization_Act_of_1942 https://en.m.wikipedia.org/wiki/Stabilization_Act_of_1942

qalmakka 6y ago

I'm European, and I think that healthcare should be considered a human right. Not giving someone in need a potentially life-saving medical treatment is completely unfair, and a big red flag honestly. Life doesn't give the same opportunities to everyone, some people have been born in better environments or have simply been less fortunate then others, and I think it's the state's responsibility to create a system where these things are taken into account. Denying this is plain greed from the richest who don't want to subsidize healthcare for the poorest, without realizing that a society where people are less worried about their future would benefit them too; it puzzles me that so many people on the other side of the pond think of this almost as if it was some form of bolshevism while it is instead just plain and simple basic human decency.

Darmody 6y ago
This is not about the rich subsidizing the poor. That's not how healthcare works in Europe. Y pay my share as everybody else for our healthcare. If someone can't pay it is still covered by all the other people paying. That doesn't mean the rich are subsidizing us. The problem with the healthcare in the US goes beyond that. Everything is insanely corrupt to make things expensive. That's why they spent way more per capita that many other countries but get almost nothing in return.
- JumpCrisscross 6y ago
  > If someone can't pay it is still covered by all the other people paying. That doesn't mean the rich are subsidizing us. That’s exactly what it means. The person who couldn’t pay has their costs subsidised by those who do. If nobody in the system pays more than they use, and anyone uses more than they pay, the system tends de-stabilises.
  - DerDangDerDang 6y ago
    It’s not ‘the rich’ paying in that case. It’s ‘the majority’.
    - 6y ago

PostThisTooFast 6y ago

This is a case of incompetent legislation degrading the lives of millions of people. The insurance-benefits loophole in the WWII salary caps should’ve been plugged as soon as it emerged. But nope. Now we have a world-class mess.

blackrock 6y ago

Please do something useful and fund a movement to dissociate the two. People are imprisoned to their employers that provides decent health care, especially those with family and children. Health care costs should be completely 100% tax deductible. When I go to the dentist, I have no clue what he is going to charge me. He could price a procedure at $1000 or $5000. I, as an individual, have no ability to negotiate with him about his price. I just know that I have a damn root canal, and I’m dying in pain, so fix it! And then, you’re slapped with the expensive bill.

dwd 6y ago
Rather than health care costs being completely 100% tax deductible, you just need the health insurance premiums to be covered, and you can index the deduction against taxable income if you want. The kicker, and this is where the US mindset gets hung-up is that you need to incentivise the insurers to cover everyone (including preexisting conditions) by making it mandatory for everyone to have health insurance so there are enough healthy people (who don't make claims) in the system to make it profitable.
- JumpCrisscross 6y ago
  > you need to incentivise the insurers to cover everyone (including preexisting conditions) by making it mandatory for everyone to have health insurance There’s a stupid simple workaround. Everyone gets taxed equal to the lowest-tier health insurance. When a health insurer signs someone up, they can claim from this kitty. Insurers can’t deny signing someone up for the lowest tier. When insurers breach certain actuarial limits, for example, if their pool of insured proves unusually old or sick, they can claim from this kitty. If the limits are properly set, healthy people foregoing insurance becomes a non-issue. They’re pre-paying for a benefit they fail to claim.
  - brokensegue 6y ago
    Isn't this basically what Obamacare tried to do? Except with a lower tax?

fallingfrog 6y ago

When the current health insurance system was created in the 1950’s, there was a very specific family structure in the United States where the man would work for a wage, and the woman would stay at home with the children. So if the health insurance was attached to the man’s job, then she was dependent on him for healthcare. So you have to understand that on the American right wing, the current health care system is seen as a lynchpin of the “American way of life”. Not only that but as many black people work the kinds of low wage jobs that don’t offer health care. If we created a public system for everyone, then taxes on white income and property would be used to pay for black people to have health care, something which in the United States is a hard sell. That’s why you will often see people holding signs saying something to the effect of “racial equality is communism”.

amanaplanacanal 6y ago

This biggest problem with employer paid health insurance is that the people who receive it are sheltered from a lot of the problems with the current system. It’s easy to say everything’s fine when you are happy with your current situation. Imagine if senators and congress had to buy their own individual plans.

dpeck 6y ago
this is the answer to why so many things are the way they are. Those with enough money to make something not be a problem, don't tend to even think about it again after writing the check/swiping the card.

chansiky 6y ago

> But employer-based insurance is heavily subsidized by the federal government. I don't know enough about how the health insurance beast works, but it would seem that if the federal government stopped giving an unfair advantage to organizations, then the unfair advantage would stop existing for these organizations that were given the unfair advantage and fairness would somewhat return for individual persons.